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Oxford University Press makes no representation, express or implied, that the drug dosages in this book are correct. Readers must therefore always check the product information and clinical procedures with the most up to date published product information and data sheets provided by the manufacturers and the most recent codes of conduct and safety regulations. The authors and the publishers do not accept responsibility or legal liability for any errors in the text or for the misuse or misapplication of material in this work. Except where otherwise stated, drug dosages and recommendations are for the non-pregnant adult who is not breastfeeding.

This chapter is based on the work of Chris Main and Paul Watson. It includes the more recent developments made by Peter O’Sullivan, David Butler, Lorimer Moseley, and Michael Thacker who have enhanced the evidence base for musculoskeletal clinicians with their work on a cognitive functional (CFT) approach and their understanding of modern pain biology and neuroscience to enable patients to change their behaviour. Research into the factors that make musculoskeletal pain likely to become chronic has continued to highlight psychosocial factors. Although the original research related to low back pain, similar research for other areas of the spine has revealed that similar factors operate there. Also, there are indications that peripheral areas such as the shoulder are subject to prolongation of pain with adverse psychological and social factors.

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